Accuracy of Fibula Reconstruction Using Patient‐Specific Cad/Cam Plates: A Multicenter Study on 47 Patients

Zavattero, Emanuele; Bolzoni, Alessandro; Dell'Aversana, Giovanni; Sant'Agata, Marco; Massarelli, Olindo; Ferri, Andrea; Monaca, Marco Della; Copelli, Chiara; Gessaroli, Manlio; Valsecchi, S.; Borbon, Claudia; Beltramini, Giada Anna; Ramieri, Guglielmo; Valentini, Valentino; Tartaro, Gian Paolo; Cocchi, R; Varazzani, A; Califano, Luigi; Baj, A.

doi:10.1002/lary.29379

Cited by 22 publications

(16 citation statements)

References 13 publications

(12 reference statements)

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“…However, the greatest challenge that remains is how to most accurately shape vascularized bone aps so that facial symmetry, as well as function, are best restored and minimize the operative time of such complex surgeries [10]. Conventional techniques, either freehand or MB-approached, depend mainly on the surgeons' experience and lack effective quantitative strategies [10,[16][17][18][19]. The advent of VSP, including CAD-CAM, has overcome the dilemma and changed the way of bony reconstruction in the past few years [5,20,21].…”

Section: Discussionmentioning

confidence: 99%

Aesthetic Reconstruction of Onco-surgical Mandibular Defects Using Free Fibular Flap with and without CAD/CAM Customized Osteotomy Guide: A Randomized Controlled Clinical Trial

Al-Sabahi

Jamali

Shindy

et al. 2022

Preprint

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Background Reconstruction of mandibular defects following ablative surgery remains a challenge even for experienced surgeons. Virtual planning and guided surgery, including computer-aided design/computer-aided manufacturing (CAD/CAM), afford optimized ways by which to plan complex surgery. This study aimed to evaluate and compare aesthetic outcome and surgical efficiency of free fibular flap (FFF) with and without CAD/CAM customized osteotomy guide (COG) for reconstruction of onco-surgical mandibular defects. Methods Twenty-two patients indicated for segmental mandibulectomy were randomly assigned to either CAD/CAM with COG group or that without COG- Model based reconstruction (MB group) at a 1:1 ratio. Aesthetic outcomes were evaluated by means of morphometric assessment and comparison for each differential area (DAr) and angle (DAn) in the affected side to the contralateral side of the mandible using computerized digital imaging analysis (CDIA) based on the post-operative 3D CT-scan. Subjective evaluation was performed using the Visual Analogue Scale (VAS) and Patient’s Satisfaction Score (PSS). Surgical efficiency was a secondary outcome and evaluated as total operative time and ischemia time. Results The mean sagittal DAr was significantly lower in the COG group (277.28 ± 127.05 vs 398.67 ± 139.10 mm2, P = 0.045). Although there was an improvement in the axial DAr (147.61 ± 55.42 vs 183.68 ± 72.85 mm2), the difference was not statistically significant (P = 0.206). The mean differences (Δ) in both sagittal and coronal DAn were significantly lower in the COG group than in the MB group (6.11 ± 3.46 and 1.77 ± 1.12° vs 9.53 ± 4.17 and 3.44 ± 2.34°), respectively. There were no statistically significant differences in the axial DAn between the two groups (P = 0.386). The PSS was significantly higher in the COG group, reflecting better aesthetic satisfaction than in the MB group (P = 0.041). The total operation and ischemia time were significantly shorter in favor of the COG group with a mean of (562.91 ± 51.22, 97.55 ± 16.80 min vs 663.55 ± 53.43, 172.45 ± 21.87 min), respectively. Conclusion The CAD/CAM with COG is more reliable and highly valuable in enhancing aesthetic outcomes and surgical efficiency of mandibular reconstruction by FFF compared to that without COG (MB reconstruction). Trial registration: This trial was registered at ClinicalTrials.gov. Registration number: NCT03757273. Registration date: 28/11/2018.

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Section: Discussionmentioning

confidence: 99%

Aesthetic Reconstruction of Onco-surgical Mandibular Defects Using Free Fibular Flap with and without CAD/CAM Customized Osteotomy Guide: A Randomized Controlled Clinical Trial

Al-Sabahi

Jamali

Shindy

et al. 2022

Preprint

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“…Since fibula flaps were used in most of our cases, we utilized 7.0% as the current failure rate of free flap. We reviewed the available studies using PSSP in maxillofacial reconstruction ( Table 1 ) and pooled the current failure rate of PSSP as 4.4% ( n = 6/136) ( 19 , 23 – 27 ). Therefore, the overall success rate of implementing free flap and PSSP was 88.9%, and the acceptable level of surgical failure (p0) was set at 11.1% [100% − (100% − 7.0%) × (100% − 4.4%)] in the CUSUM analysis.…”

Section: Methodsmentioning

confidence: 99%

The Learning Curve of Computer-Assisted Free Flap Jaw Reconstruction Surgery Using 3D-Printed Patient-Specific Plates: A Cumulative Sum Analysis

et al. 2021

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BackgroundComputer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution.MethodsIn a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis.ResultsFrom December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p < 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively.ConclusionOur results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8–17 cases.

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“…With the development of CAS and PSI, the accuracy and efficiency of jaw reconstruction have been significantly increased [ 28 ]. On top of restoring facial aesthetics and maintaining the airway, the timely and predictable restoration of the mastication function has become the new aim of functional jaw reconstruction.…”

Section: Current Developmentmentioning

confidence: 99%

Current Trends in the Reconstruction and Rehabilitation of Jaw following Ablative Surgery

Hakim

Melville

et al. 2022

Cancers

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The reconstruction and rehabilitation of jaws following ablative surgery have been transformed in recent years by the development of computer-assisted surgery and virtual surgical planning. In this narrative literature review, we aim to discuss the current state-of-the-art jaw reconstruction, and to preview the potential future developments. The application of patient-specific implants and the “jaw-in-a-day technique” have made the fast restoration of jaws’ function and aesthetics possible. The improved efficiency of primary reconstructive surgery allows for the rehabilitation of neurosensory function following ablative surgery. Currently, a great deal of research has been conducted on augmented/mixed reality, artificial intelligence, virtual surgical planning for soft tissue reconstruction, and the rehabilitation of the stomatognathic system. This will lead to an even more exciting future for the functional reconstruction and rehabilitation of the jaw following ablative surgery.

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Accuracy of Fibula Reconstruction Using Patient‐Specific Cad/Cam Plates: A Multicenter Study on 47 Patients

Cited by 22 publications

References 13 publications

Aesthetic Reconstruction of Onco-surgical Mandibular Defects Using Free Fibular Flap with and without CAD/CAM Customized Osteotomy Guide: A Randomized Controlled Clinical Trial

Aesthetic Reconstruction of Onco-surgical Mandibular Defects Using Free Fibular Flap with and without CAD/CAM Customized Osteotomy Guide: A Randomized Controlled Clinical Trial

The Learning Curve of Computer-Assisted Free Flap Jaw Reconstruction Surgery Using 3D-Printed Patient-Specific Plates: A Cumulative Sum Analysis

Current Trends in the Reconstruction and Rehabilitation of Jaw following Ablative Surgery

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